A cluster randomized controlled trial of the clinical and cost effectiveness of Facilitated Access to Mutual Aid for adults with problem alcohol and drug use (FAMA).

Research question: To assess whether attendance and participation at Mutual Aid Groups (MAGs) (eg. Twelve Step Groups (TSGs) of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) or SMART recovery) among patients attending community alcohol and drug treatment services can be improved by professional treatment staff providing “Facilitated Access” to MAGs. Background: Alcohol and Drug (AoD) treatment can help people gain control over their substance use, but many drop out of treatment early. There has been a reduction in addiction treatment funding leading to less counselling and support. MAGs involve groups of people supporting each other, are voluntary and are free to attend. Research from the USA shows that people attending MAGs receive greater benefits (higher abstinence rates) than those not attending and attending both professional AoD treatment services and MAGs has been linked to less alcohol and/or drug use compared to attending either professional treatment services or MAGs alone. Encouraging attendance and participation at MAGs among patients receiving community AoD treatment could potentially benefit patients. Although national guidance recommends that AoD treatment staff promote MAGs to their patients, UK treatment staff often have limited knowledge about MAGs and do not encourage their patients. As a result, few patients attend MAGs, and an opportunity is being missed. Aim and objectives: To adapt a Facilitated Access to Mutual Aid (FAMA) intervention (staff providing patients with list of local MAGs, reviewing MAG information together, addressing concerns, and connecting service users with a local MAG member to accompany the participant to the meeting) and training for delivery in community AoD services in England and evaluate its clinical and cost effectiveness in increasing MAG attendance and engagement. Methods: An existing treatment manual for providing FAMA to patients receiving community AoD treatment services will be adapted for routine UK clinical practice. Training in FAMA for AoD treatment staff will be developed. We will do this with people in community treatment, people using MAGs and community AoD treatment staff. A cluster randomised controlled trial will evaluate whether FAMA increases attendance and engagement at MAGs compared to no FAMA. The trial includes an economic evaluation. Twenty-two AoD treatment services will be recruited and randomly allocated (1:1) to provide FAMA, or no FAMA (Treatment As Usual). Nine hundred and fourteen study participants will receive the treatment their service has been allocated to and will be assessed at 6 and 12 months. Timelines for delivery: The study will be undertaken in 54 months: adapting the intervention/training between months 1-12 months, conducting the RCT between months 13-48 (recruitment months 13-36, six- and 12-month follow-up months 18-48 and analysis and report writing months 49 -54). An internal pilot will be completed between months 13 and 24. Anticipated Impact and dissemination: At the end of this study, we will have evidence from a large cluster RCT of the clinical and cost effectiveness of using FAMA in English AoD treatment services to encourage attendance at MAGs. Findings will be reported to participants and staff through open access academic peer reviewed journals, NHS Trust newsletters, participating AoD treatment services and externally through topic-specialist media.